This Week in Managed Care: April 23, 2016

This week, the top stories in managed care included the news that UnitedHealth will be exiting most Obamacare exchanges in 2017, and coverage from both the annual meeting of the Academy of Managed Care Pharmacy and the Community Oncology Conference.

Hello, I’m Brian Haug, president of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

UnitedHealth Leaves Most ACA Exchanges

UnitedHealth Group said this week that it will be exiting healthcare exchanges in more states, following news that it would leave Arkansas, Georgia and Michigan.

In a conference call, CEO Stephen Hemsley said smaller market size and the higher risk levels on the exchanges, which were set up under the Affordable Care Act, will make it hard for UnitedHealth to keep offering plans in all but a few states.

The insurer started this year on 34 exchanges, but Hemsley said by 2017 UnitedHealth will operate in just a handful. The company lost $1 billion on the exchanges from 2015 to 2016, but still reported revenue growth in the first quarter of 2016.

AMCP Annual Meeting

Price growth in specialty pharmacy is not sustainable, according to the chief medical officer of Express Scripts. Dr Steve Miller took part in a panel discussion on the future of specialty pharmacy, which took place ahead of the AMCP Managed Care & Specialty Pharmacy annual meeting.

Phil Hagerman, CEO of Diplomat Pharmacy, agreed, adding that oncology therapies are driving up costs—and the full effect is not always seen the first year a new drug hits the market.

Later Dr Miller spoke with AJMC about efforts to work with oncologists on value-based payment models. Watch the interview.

For full coverage of the AMCP meeting, visit our conference page.

Community Oncology Conference

The need to connect reimbursement with quality in cancer care was high on the agenda at the Community Oncology Conference in Orlando, Florida, where leaders discussed the many changes that practices are making to meet patient schedules and needs.

However, the lack of consensus on what “value” means in oncology is still a problem, according to Dr. Michael Diaz of the Florida Cancer Specialists and Research Institute. Said Diaz:

“We want the entire practice to achieve its quality and value metrics. We are still in the process of defining value—there’s still a lot of debate about optimal quality measures. So focusing on moving targets wouldn’t help us.”

For full coverage of the annual meeting of the Community Oncology Alliance, visit the conference page.

ACO Coalition Spring Meeting

Dr Michael Chernew, a co-editor in chief of The American Journal of Managed Care, said recently that while some experts believe as much as 30% of healthcare spending is waste, savings achieved thus far by accountable care organizations has been less than that. Dr Chernew said the upcoming spring meeting of AJMC’s ACO and Emerging Healthcare Delivery Coalition offers leaders from these entities opportunities to find out what is working so far. Watch the interview.

The Coalition’s spring meeting will take place this week, April 28th and 29th, in Scottsdale, Arizona. To join us, visit the meeting page.

For all of us at the Managed Markets News Network, I’m Brian Haug. Thanks for joining us.